WHAT IS MELASMA?

Melasma (or chloasma) refers to the dark patches that appear—most commonly in women of childbearing age—symmetrically on the cheeks, upper lip, bridge of the nose, or chin.

In any case, it is advisable to consult a dermatologist, as there are other types of spots similar to melasma that must be distinguished from it (lentigines, post-inflammatory hyperpigmentation, drug-induced hyperpigmentation, ochronosis, pigmented contact dermatitis, and poikiloderma).

WHY DOES MELASMA OCCUR?

The exact cause is unclear.

On the one hand, since it is more common during pregnancy or in women taking oral contraceptives, it is known that hormones play a role. In any case, it can also occur (and in fact is quite common) in women who do not fall into either of these two categories; therefore, there must be other factors involved that we do not yet understand.

On the other hand, melasma is more common in people with darker skin, who generally have a higher risk of hyperpigmentation. Therefore, skin tone also influences the likelihood of developing it: the darker the skin, the higher the risk of developing melasma.

Pregnancy, birth control, having darker skin, and sun exposure are the main factors involved in melasma.

Finally, we know that the key trigger for melasma is the sun. This is evident because the spots appear exclusively in areas exposed to the sun (for example, it is extremely rare to see them under the chin). Sunlight is composed of different types of waves. It is well known that ultraviolet (UV) radiation increases skin pigmentation, but in the case of melasma, you may have noticed that even visible light can stimulate its formation, which makes prevention very difficult.

HOW IS MELASMA PREVENTED?

As you might guess, the most important factor in preventing melasma is sun protection. People prone to melasma should use a sunscreen with SPF 50+ daily and reapply it if they spend more than 2 hours in the sun.

Since we know that UV radiation isn’t the only factor involved in melasma, sunscreen alone may not be enough to prevent it completely, as it protects against UV rays but not against visible light. Therefore, it’s advisable to minimize sun exposure and wear a cap or hat during the hours you spend outdoors each day.

HOW IS MELASMA TREATED?

Typically, depigmentation treatments are not performed during the summer, and we focus on preventing the appearance of new spots. In any case, sun protection in itself is already a form of treatment.

As a complement, there are sunscreens—in the form of makeup with varying levels of coverage—that can help us conceal uneven pigmentation during the summer, while also preventing this pigmentation from worsening.

Treating melasma is not easy, but we have various options that are typically started after the summer.

Treating melasma is complex: sun protection must be combined with topical depigmenting products for several weeks. In cases where this is not effective, chemical peels or laser treatments may be used. But we’ll address all these options in due time—once the summer season is over, when the sun is less intense and we can get down to business treating the dark spots on the face.

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So let’s get to the point: what types of spots are the most common? In general, when we start to worry about spots in our thirties or forties, they can be divided into two main groups.

SOLAR LENTIGO

What are solar lentigos?

They are flat spots, reminiscent of freckles, although they are usually larger. They appear in areas where we have been exposed to the sun. This exposure does not necessarily have to be the previous summer, but they are caused by all the sun accumulated throughout our lives. That is to say, you may have been taking care of the sun for decades, but if in adolescence you did something excessive, this may be the cause of these lentigines. The skin has a memory.

How to treat solar lentigos?

Lentigines respond very well to physical treatments such as laser or pulsed light. These systems work by emitting a light source that reacts with the color of the blemish. The darker the spot and the lighter the underlying skin, the more likely it is that the treatment will be successful, which is why it is especially interesting to perform the treatment at times when we are paler, as is often the case in winter.

In the following 4 weeks it is equally important to avoid the sun as much as possible. Sun exposure on “inflamed” skin after laser treatment could cause another type of stains called post-inflammatory hyperpigmentation, which is not at all desirable.

The treatment causes some changes in the spots that will last a few days/weeks: in the case of laser it can be a purplish tone or crusts and in the case of pulsed light, the spots take on a grayish color. Then they will progressively fade until they disappear.

MELASMA:

What is melasma?

Also called chloasma, they are more diffuse spots that usually cover the area of the cheeks, forehead or upper lip, usually appearing in women. Generally lighter than lentigines but larger in size. They are usually related to having gone through a pregnancy or taking contraceptives, although many women suffer from them without any of these factors. In this link I talk more about melasma.

How to treat melasma?

In general, melasma is more complex to treat than lentigines. Contrary to what one might think, physical techniques in this case do not work as well and are generally relegated to the background.

The initial approach to melasma should always include rigorous sun protection, preferably with colored products (either a tinted sunscreen or using makeup over it) to block the effect of visible light (which influences the appearance of melasma).

Specific treatment is done with depigmenting creams, which almost always include hydroquinone. This can be supplemented with retinoids or other depigmenting agents (kojic, niacinamide, tranexamic, azelaic), as well as peelings.

In recent years, moreover, scientific evidence has shown the effectiveness of an oral treatment that helps us to complement topical therapy with creams: tranexamic acid, which you can read about in this article.

Melasma reappears very frequently, so it is very important to maintain strict sun protection habits at all times (both summer and winter).

Do you have lentigos?

The post How to treat skin blemishes? first appeared on Dra. LOREA BAGAZGOITIA.

What are the white patches on my arms and legs? – Symptoms

Idiopathic guttate hypomelanosis (IGH), is more common in fair-skinned people. It appears as white, millimeter-sized patches on the skin of the legs and arms of middle-aged or older people.

They are usually more evident when you get a tan. They do not produce symptoms, nor do they itch or hurt.

In this link you can see more pictures of HIG

Why do white spots appear on the arms and legs? – Causes

Guttate hypomelanosis s a consequence of sun exposure. Not the sun of last summer, or the sun of the last few years, or the sunburn we remember because it was more intense, no. It is the result of years and years of ultraviolet rays. It is the consequence of years and years of ultraviolet rays. This somehow changes the pigment producing capacity of the skin cells and makes them work irregularly.

Guttate hypomelanosis is a mixture of sun and age. In fact, the number of “drops” usually increases with age. White patches on children’s skin are usually due to atopic dermatitis and have nothing to do with this condition.

How are white spots on the arms and legs (HIG) diagnosed? – Diagnosis

Idiopatis guttate hypomelanosis is usually diagnosed with a clinical dermatologic examination. It is interesting to have the skin evaluated by a dermatologist (in person or online dermatologist). This will help to differentiate these patches from other conditions such as vitiligo or flat warts, and to assess the various reasons that can cause white patches in summer.

In my experience as a dermatologist, most cases do not require a medical test or examination.

How is idiopathic hypomelanosis treated ? – Treatment

First of all, as a dermatologist, I can assure you that this condition has no medical relevance. However, it can have some aesthetic implications, so it is normal to try to find a solution. However, doctors do not have completely effective treatments. Strangely enough, there is no miracle laser that can erase these small spots.

Secondly, we do not have any topical treatment (cream) with scientific evidence. Topical corticosteroids and calcineurin inhibitors have been tried with variable results.

Finally, some publications have shown a slight improvement with cryotherapy or fractionated laser, but the results are far from complete. In general, in my experience as a dermatologist, I usually do not recommend any treatment as the possibility of improvement is almost non-existent.

How to prevent white spots on arms and legs? – Prevention

We know that the appearance of these little white spots on the arms and legs is the result of exposure to the sun over the years. The accumulated solar “load” cannot be erased. However, we can avoid accumulating more sun damage. Therefore, if you suffer from guttate hypomelanosis , it is advisable to reinforce your sun protection habits.

On the other hand, if you do not yet have these spots on your arms or legs and you are reading this article, increase your prevention and use sunscreen rigorously. In this way, you will be much less likely to suffer from hypomelanosis in the future.

Do you get these little white spots in summer?

The post White spots on the arms and legs: guttate hypomelanosis first appeared on Dra. LOREA BAGAZGOITIA.